Clinical Case Study

Neonatal Jaundice

Case Presentation

Martin and Kim were both twenty-five when they had Michael, their first child. Kim remained very healthy during her pregnancy and went into labor at 9:00 a.m., just 3 days after her due date. Delivery went quite smoothly, and that evening, mother and child rested comfortably. Two days later, Kim and Michael were released from the hospital. That evening at feeding time, Kim noticed that the whites of Michael's eyes seemed just slightly yellow, a condition that worsened noticeably by the next morning. Kim called the pediatrician and made an appointment for that morning.

Upon examining Michael, the pediatrician informed Martin and Kim that the infant had neonatal jaundice, a condition quite common in newborns and one that need not cause them too much concern. The physician explained that neonatal jaundice was the result of the normal destruction of old or worn fetal red blood cells and the inability of the newborn's liver to effectively process bilirubin, a chemical produced when red blood cells are destroyed. The physician told the parents he would like to see Michael every other day in order to monitor blood bilirubin concentration until the bilirubin concentration dropped into the normal range. He recommended that Kim feed Michael frequently and instructed them to place Michael in sunlight whenever possible.

Case Background

Neonatal jaundice in a disorder that affects nearly 50% of all newborns to at least a small degree. The yellow coloration of the skin and sclera of the eyes is due to the accumulation of bilirubin in adipose tissue and its adherence to collagen fibers. In neonatal jaundice, the excess bilirubin is not due to an abnormal level of red blood cell destruction. It is due to the inability of the young liver cells to conjugate bilirubin, or make it soluble in bile, so that it can be excreted and removed from the body by the digestive tract. This inability is corrected, usually within one week, as the liver cells synthesize the conjugation enzymes. If uncorrected, sufficiently high bilirubin concentrations can cause brain damage. Frequent feedings of a newborn with jaundice increase gastrointestinal tract motility and decrease the likelihood of reabsorbing significant amounts of bilirubin in the small intestine. Radiation from sunlight alters the chemical form of bilirubin, making is easier for the liver to excrete.

1		Which organs are primarily responsible for removing old or worn red blood cells from circulation?
2		List the normal sequence of steps in the breakdown of hemoglobin.
3		Why would you expect the sclera of the eyes to turn yellow as a result of jaundice?